Massage guns have surged in popularity, becoming a common tool in clinical and sports settings. These devices, which deliver percussive or vibration therapy, are used for pre-activity warm-ups, post-activity recovery, and as part of various treatment regimens. However, despite their widespread use, there remains a gap in understanding their effectiveness and optimal application. This article aims to provide a comprehensive overview of the benefits of massage guns, drawing on available research to guide practitioners and users.
Historical Context and Development
Percussive or vibration therapy has ancient roots, dating back to the ancient Greeks who used mechanical vibrations to aid injury recovery. Modern percussive therapy involves applying manual or mechanical techniques to the tissues. Tapotement, a common manual technique, involves rapid, compressive tapping of the tissues to create vibration and shock.
The development of mechanical percussion devices aimed to replicate or enhance the effects of manual percussion. The first such device was created in the 1950s. Today, a variety of devices are available, including platforms, wearable devices, belts, foam rollers, and massage guns. Massage guns are handheld devices that use rapid tip movement to deliver bursts of pressure and vibration to myofascial tissues.
Massage Guns: Design and Functionality
Massage guns are handheld mechanical devices resembling small jackhammers, powered by electricity or batteries. They come with various shaped applicator tips, such as large and small balls, flat tips, bullet/pointy tips, and forks. These devices deliver percussive therapy by rapidly impacting the tissues, promoting blood flow, reducing myofascial restrictions, improving range of motion, alleviating pain, and breaking up trigger points.
Despite their increasing popularity, there is no standardized agreement on massage gun development. Commercial manufacturers produce diverse models with varying shapes, sizes, and settings, including speeds/frequencies (17-53 Hz), amplitudes, and applicator tips.
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Lack of Consensus in Application Parameters
A significant challenge in utilizing massage guns is the lack of consensus on application parameters. Research indicates a wide range of frequencies (5-300 Hz), amplitudes (0.12-12 mm), and durations (6 seconds to 30 minutes) used in local vibration therapy. Similarly, clinicians report varied massage gun settings, with speeds ranging from 17-40 Hz, treatment times from 30-180 seconds, and cadences from 2-10 seconds.
The absence of standardized parameters is a concern, as many clinicians rely on anecdotal information rather than empirical evidence, potentially compromising optimal clinical practice and patient management.
Systematic Review of Massage Gun Effects
To address the need for evidence-based guidance, a systematic review was conducted to evaluate the effects of massage guns in healthy and unhealthy individuals. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Methodology
The review involved a comprehensive search of electronic databases, including PubMed, PEDro, Scopus, SPORTDiscus, Web of Science, and Google Scholar. The search strategy combined keywords, mesh terms, and established search filters, focusing on terms such as "percussive therapy," "vibration therapy," and "massage gun." No restrictions were placed on language or publication date.
Two independent authors screened the titles and abstracts of identified studies to assess their eligibility. Studies meeting the criteria were gathered in EndNote, and duplicates were removed. Full versions of the preliminary included studies were retrieved and evaluated for inclusion and exclusion criteria. Disagreements were resolved through discussion or arbitration by a third reviewer.
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Data collection and extraction were performed by one author and checked by another to ensure consistency. Extracted data included study titles, authors, publication years, instruments used, participant characteristics, objectives, intervention descriptions, control group descriptions, outcomes, assessment times, results, and conclusions.
Study Selection
The initial database searches returned 8586 records, of which 8305 were duplicates. After screening 281 records, only 11 studies met the inclusion criteria.
Risk of Bias Assessment
The risk of bias in the included studies was independently assessed by two reviewers using Cochrane’s Risk of Bias tool, version 2 (RoB 2) and Cochrane’s Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Randomized studies were evaluated using five RoB 2 domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Non-randomized studies were evaluated using seven ROBINS-I domains: confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of the reported result.
The RoB 2 assessment revealed problematic domains in the randomization process and measurement of the outcome, with most evaluations indicating a moderate risk of bias. The ROBINS-I assessment identified confounding, selection of participants, and selection of the reported result as areas of concern.
Characteristics of Included Studies
The included studies were primarily conducted in Europe (55%), followed by North America (27%) and Asia (18%). Most studies were published in peer-reviewed journals, with a smaller number appearing as academic theses. Funding sources were reported in some studies but not in others, and conflicts of interest were noted in a minority of cases.
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The studies were published between 2020 and 2022, with the majority in 2022. Study designs included crossovers and RCTs, with no treatment/placebo/sham and foam roller being the most frequent comparator groups. The outcomes explored related to performance (~65%) and recovery (~35%), with strength, range of motion, and fatigue being the most assessed.
Massage guns were applied to the upper (28%) and lower (72%) body segments, with the gastrocnemius, hamstring, and quadriceps muscle groups being the most frequently targeted. The most used massage gun was Theragun®, followed by Hypervolt® and other brands. The ball-shaped applicator tip was the most commonly used.
The frequency applied ranged from 60 Hz to 20 Hz, with 53 Hz and 40 Hz being the most common. Intervention times ranged from 15 seconds to 5 minutes per muscular group and 2 minutes to 16 minutes for the overall session. Across the 11 studies, 281 participants were enrolled, with an average of 26 per study.
Key Findings and Results
Flexibility
Massage guns have demonstrated effectiveness in improving the flexibility of the iliopsoas, hamstrings, triceps suralis, and posterior chain muscles.
Performance
In strength, balance, acceleration, agility, and explosive activities, massage guns either did not show improvements or even led to a decrease in performance. A study found that percussive therapy and global postural reeducation showed improvement in the posterior chain flexibility. When comparing the two techniques, percussive therapy differs from global postural reeducation in the very active group of individuals
Recovery
Massage guns have been shown to be cost-effective for stiffness reduction, range of motion, and strength improvements after a fatigue protocol. A study found that the application of different recovery techniques had positive effects for contraction time and radial displacement in the treated leg compared to the untreated leg.
Other Outcomes
No significant differences were found in contraction time, rating of perceived exertion, or lactate concentration following massage gun use.
Specific Study Results
- Alonso-Calvete et al.: There were no differences between percussive therapy and passive recovery in lactate clearance.
- Alvarado et al.: Percussion therapy significantly decreased peak ankle eversion during the drop jump and improved ROM measures, including the Thomas test, 90-90 hamstring, and ankle lunge.
- García-Sillero et al.: Percussive therapy resulted in a greater total number of repetitions compared to the control group.
Enhanced Muscle Strength and Power
Hernandez et al. found that vibration therapy increased isometric peak force, rate of force development, and peak power output.
Balance Improvement
Costa et al. showed that local vibration could acutely improve balance, highlighting its potential for fall prevention.
Pain Reduction and Functional Improvement
Kocyigit et al. found that vibration therapy effectively reduced pain and improved functional capacity in patients with chronic pain syndromes.
Discussion and Implications
The systematic review provides valuable insights into the effects of massage guns on various outcomes. While massage guns appear to be effective in improving flexibility and aiding recovery, their impact on performance-related outcomes is less clear. The findings suggest that massage guns can be a cost-effective tool for reducing stiffness and improving range of motion and strength after fatigue.
The review also highlights the need for standardized parameters in massage gun application. The lack of consensus on frequency, amplitude, and duration raises concerns about the consistency and effectiveness of treatments. Future research should focus on identifying optimal parameters for different populations and outcomes.